The following description is provided to assist the understanding of the reader. None of the information provided or references cited is admitted to be prior art.
The present invention relates generally to the field of insurance policy analysis and more particularly to insurance claims analysis.
It is a common practice for large employers to provide life insurance as a standard benefit or incentive to its employees. Generally, employers pay most, if not all, of the premiums on these life insurance policies. Life insurance benefits are typically bundled with other benefits and provided to the employee as a package. The group size of the covered employees often warrants a substantially discounted premium and translates to similarly reduced benefit values. As a result, it is common for the beneficiaries of such policies to be unaware of the policy's existence when a valid claim arises. Consequently, billions of dollars in death benefits are held by insurance companies awaiting claim from, for example, the relatives of these employees.
There are several parties who have an interest in these claims including, but not limited to: the beneficiaries have an interest in being made aware of the existence of their rights to claim these benefits; the employers have an interest in ensuring that their employees are paid their due benefits in return for the consideration provided, often by the employer, in the form of premiums; and the state has an interest in ensuring that the employer and insurance company are complying with all applicable laws governing such life insurance policies. Audit enforcement is based on a group life insurance contract providing the face amount of coverage, rules of employee eligibility, and premium payment responsibilities.
Since a beneficiary's ignorance of the existence of a policy renders them incapable of pursuing a claim, it is generally up to the employer or government to effect the final dispensation of these benefits. The data about such policies often predates computer records, spans decades, and is incomplete within any of the subject entities (i.e. no single entity knows the insured's name, social security number (SSN), benefit amount, policy date, premium payment records and effective coverage dates, contract terms, insured's date of death, insured's final address, beneficiary names, addresses, and SSN, whether a claim has been made, date and amount of any payout, etc.). As a result, the effort involved in reconciling or auditing these benefits is generally prohibitive.
Therefore, there is a need for systems and methods for analyzing insurance plans. In addition, there is a need for systems and methods for analyzing insurance claim liabilities. In addition, there is a need for systems and methods for analyzing compliance with state or federal insurance laws.